WILMINGTON — While every other health care system is expanding with brick and mortar locations throughout Delaware,
St. Francis Hospital on the west side of Wilmington is looking at how to serve patients with more options from within.
That means taking a less than traditional approach within its own four walls, including the creation of a healthy village inside the century-old hospital in Wilmington. Under the ownership of Trinity Health, St. Francis Hospital has started on a path to rethink how it offers care to its neighbors.
It all starts with a plan to create a one-stop shop for physical, behavioral and social health services inside the century-old hospital in one of Wilmington’s most diverse neighborhood of Hilltop.
Instead of continuing business as normal, St. Francis Hospital is quietly undergoing a slow renovation process inside its four walls. When patients walk through the main entrance, the hope is that one day they will be greeted by a series of offices, each fitted out with a different nonprofit or community service organization to offer a helping hand when needed.
Right now, patients are greeted with a colorful mural depicting townhomes that line Wilmington streets. It’s fitting, as one day it hopes to be turned into a “Main Street” of services.
“Our objective is to provide the help to individuals but without the stigma,” said Lillian Schonewolf, Trinity Health Mid-Atlantic's Vice President for Community Health and Well Being. “We want people to have the opportunity to be a part of their decision making as well.”
It Takes a Village
Healthy village concepts have been on the rise in the last decade as the Affordable Care Act required private insurers to recommend preventive services without any patient cost-sharing. But in Delaware, it’s a relatively new concept, with the first in the state launched at the former Bayhealth Milford hospital in 2020 by
Nationwide Healthcare Services, which owns and operates what is now known as the Milford Wellness Village.
The idea is to offer a variety of ambulatory outpatient and nonprofit-type services that can be accomplished in a short walk within one campus, including services such as a lab, pharmacy, diagnostics, physical therapy and primary doctor’s offices. But St. Francis Hospital hopes to break the mold by turning to its existing office spaces for that concept instead of acquiring more buildings or breaking ground.
[caption id="attachment_469391" align="alignleft" width="696"]

Yolanda Garcia, a certified health worker at St. Francis, reviews the recent donations of car seats and food that arrived that morning for the community health center. | DBT PHOTO BY JUSTIN HEYES/MOONLOOP PHOTOGRAPHY[/caption]
St. Francis’ parent company, Trinity Health Mid-Atlantic, had already explored the concept for one of its other locations in west Philadelphia. But as St. Francis had to figure out how to break out of ChristianaCare’s growing shadow as it expanded throughout the state and into Pennsylvania, Schonewolf said something had to change.
Over the years, Schonewolf said Trinity Mid-Atlantic had asked St. Francis leadership to explore possibly expanding further out of the city — a common path Delaware health care systems have walked, particularly in Sussex County where the growing population has drawn those organizations to open many new medical facilities in Long Neck, Millsboro, Harbeson and other areas.
But instead, St. Francis opted to return to its roots as a faith-based nonprofit organization and serve as a safety net for the immediate community in a five-mile radius. Admission statistics show that most of its patient base is in the Hilltop community.
St. Francis had 400 beds three years ago, but as representatives told the Delaware News Journal in 2022, only about
70 were filled at any one time. Today, it has 175 beds and continues to downsize as it forges ahead with its healthy village which could bring the hospital down to 100 beds in the coming months. The hospital system reported $434 million in patient revenue in Fiscal Year 2023.
“You’re not seeing people being admitted as often as you were with ChristianaCare right down the street. But we had to think about what really makes sense for this community,” she said.
That community that surrounds St. Francis is one of Wilmington’s most diverse — and is a few blocks away from a neighborhood with some of the most hardship. The median household income for the neighborhood is $40,391, according to St. Francis Hospital’s 2023
community needs assessment report, which is below the state’s median average of $81,361.
More than 30% of Wilmington residents spend more than a third of their income on rent and about 12% of the city’s population experience food insecurity at some point each year.
In the five-mile radius directly around the health care facility, 14% of neighboring community members are Latino while 52% are Black, according to St. Francis Hospital representatives, with most of those patients arriving on foot.
“It’s only 20% of a person’s life that’s impacted by health care by seeing us. It’s the 80% we have to focus on before they come to us,” Schonewolf said. “The biggest issue is when someone comes to the emergency room, we can provide all the referrals we want. But we don’t know what happens after they leave. Oftentimes the same homeless individual who is dealing with mental health issues, food and housing insecurity is going to come back because those issues affect their health.”
The path ahead
St. Francis is still committed to offering emergency and clinical care, but it’s likely that it will look different. Schonewolf said that the hospital will downsize its inpatient beds, but it’s yet to be determined what exactly the wraparound services to support the west side of Wilmington would look like.
Schonewolf and her team interviewed residents, St. Francis Board Members, state and
[caption id="attachment_469392" align="alignright" width="300"]

Formerly known as the St. Francis gift shop, the community health center offers residents a chance to walk in and get hygine products, toys, medical and baby supplies. | DBT PHOTO BY JUSTIN HEYES/MOONLOOP PHOTOGRAPHY[/caption]
county lawmakers who represent Wilmington and more, to learn about what services they need. That resulted in an action plan that focuses on behavioral health, workforce development, health equity and senior services and housing while also outlining potential partners to work with, such as Nemours Children Health, the YWCA, the Limen House, the HOPE Commission and more.
“If someone has $10 and they have the choice of buying a meal or getting their medicine, they’re likely to choose the meal,” Schonewolf said. “But if we can have that conversation and find out they’re out of food, we can walk them down the hall and get them the help they need without making that choice.”
That line of thinking resulted in one of the organization’s healthy villages first initiatives: the health equity center.
On the first floor, there was a gift shop formerly run by the women’s auxiliary until it was shuttered in 2020. Now, St. Francis has repurposed it as a space where people can walk in and receive food, hygienic products, car seats, baby formula, diapers, pack ‘n plays and even toys for children. Each patient can schedule an initial appointment with community health workers to get a sense of what their needs are and help get them in touch with other services.
All items inside the health equity center are sourced from partners like the Food Bank of Delaware, Padua High School and Catholic Charities of Wilmington.
Future plans for St. Francis that would address other community needs also include an affordable living complex called the Vistas. To make that plan work, the hospital would build on top of the existing parking garage and build a 57-unit complex in its place with Cornerstone West CDC, though plans are pending zoning approval.
As for workforce development, there are discussions in the works seeking to restart the in-house coffee shop with a nonprofit that helps those battling substance abuse get back on their feet, offering a way to train a new workforce while bringing back that amenity after it was closed during the COVID-19 pandemic.
Stacy Ferguson, the project manager of St. Francis’ healthy village, said that her past work in social services has shown her the deep impact health care and nonprofits can have on a resident’s life. It’s at the forefront of her mind as she and Schonewolf continue to forge ahead for the project.
“As part of this, we want to be a part of the systemic change in the community surrounding St. Francis. In the past, I’ve worked with people who feel like they’re not worthy of the care that they should be getting,” Ferguson said. “We want that stigma to change. There’s a great community surrounding us. I’ve been to some community events on the west side, and they come out. We just have to support them.”
So far, committed partners still include Delaware Hospice which has now moved to a scattered bed model instead of using a suite and the HOPE Commission which aims to lower recidivism by helping ex-offenders re-enter society and will enter in the second year of the project.
Conversations are ongoing with prospective community partners and leases are in negotiation. The leases range between two and five years, according to St. Francis representatives.
Even though the renovation work is just starting for the healthy villages, in some ways, it’s already built an invisible Main Street of services with the connections Schonewolf and Fergeson have forged in the planning process.
“Just being able to pick up the phone and reach out partners and get information we need is already incredible,” Schonewolf said. “During this process, we made it clear to these service providers that we don’t want them to leave, because the community trusts you. And we can’t lose that trust. What we need is for you to join us.”
Editor's note: a previous version of this story incorrectly reported that St. Francis would demolish an existing parking garage. St. Francis plans to build the affordable housing ontop the garage.